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Aetna Better Health of Kansas, is committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for talent like you who value excellence, integrity, caring and innovation. As an employee, youll join a team dedicated to improving the lives of Aetna Better Health of Kansas members. We value diversity and are dedicated to helping you achieve your career goals.

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and
strategies, policies and programs are comprised of network management, clinical coverage, and policies.

Nurse Case Manager is responsible for telephonic and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a members overall wellness
through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Through the use of clinical tools and information/data review, conducts an evaluation of members needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact
functionality.

Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the members level of
work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status
and health needs based on key questions and conversation.

Pay Range

The typical pay range for this role is:
Minimum: 55,300
Maximum: 118,900

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

- Active and unrestricted RN licensure in the state of KS.

- Willing and able to travel using your own vehicle up to 50% of their time to meet members face to face in Sedgwick county and surrounding areas KS.

Case Manager RN - Field